SALTER VERSUS DEGA OSTEOTOMY AFTER OPEN REDUCTION OF DEVELOPMENTAL DYSPLASIA OF THE HIP IN YOUNG CHILDREN
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Keywords
Developmental Dysplasia of the Hip, Osteotomy, Salter Osteotomy, Dega Osteotomy, Acetabular Index, Hip Dislocation, Child, Treatment Outcome, Radiographic Evaluation.
Abstract
Background: Developmental dysplasia of the hip is a major pediatric concern. Traditional osteotomies, including Salter and Dega, are widely practiced, yet data remain scarce and controversial in young children. Therefore, this study was conducted to provide clarity.
Objectives: To compare Salter and Dega osteotomies after open reduction of developmental dysplasia of the hip in young children with respect to clinical outcomes and acetabular index (AI).
Duration: Six months w.e.f 15th July, 2022 to 14th Jan, 2023
Methodology: After ethical approval, 60 children with DDH were enrolled, counseled, and randomized by lottery to undergo Salter or Dega osteotomy following open reduction. Preoperative assessment included history, examination, acetabular index (AI), and McKay’s criteria. Standard operative protocols and monitoring were applied. Postoperative AI and clinical outcomes were evaluated immediately and at 12 months. All measurements were performed by the investigator to minimize bias.
Results: In 60 children with developmental dysplasia of the hip, Salter osteotomy achieved a significantly lower acetabular index (17.48±3.95 vs. 21.61±4.02, p=0.000) and more excellent outcomes (86.2% vs. 50.0%, p=0.027) than Dega osteotomy.
Conclusion: Both Salter and Dega osteotomies proved effective after open reduction for developmental dysplasia of the hip. However, Salter osteotomy showed significantly better outcomes, with lower acetabular index values and higher rates of excellent clinical results. These findings establish Salter osteotomy as the superior technique for young children requiring hip reconstruction.
References
2. Vaidya S, Aroojis A, Mehta R. Developmental dysplasia of hip and post-natal positioning: role of swaddling and baby-wearing. Indian J Orthop. 2021;55(6):1410-6.
3. Gu Y, Jin W, Zhang H, Shi Z, Yue Y, Yan Z, et al. What are the significant factors affecting pain in patients with hartofilakidis type Ι developmental dysplasia of the hip?. J Orthop Surg Res. 2021;16(1):611.
4. Johari AN, Pandey RA, Mahapatra SK, John B. Causes of late-presenting developmental dislocation of the hip beyond 12 months of age: a pilot study. Indian J Med Res. 2023;157(5):403-11.
5. Peracha MA, Anwar K, Faisal Z, Azfar M, Tago IA, Shahwani KS. The prevalence of risk factors for developmental dysplasia of the hip (ddh) in children. J Popul Ther Clin Pharmacol. 2024;31(6):1156-60.
6. Alhaddad A, Gronfula AG, Alsharif TH, Khawjah AA, Alali MY, Jawad KM, et al. An overview of developmental dysplasia of the hip and its management timing and approaches. Cureus. 2023;15(9):e45503.
7. Bhatti A, Soomro MH, Chinoy MA, Zaman AU, Baloch MA, Ali P, et al. Epidemiology of developmental dysplasia of hip in Pakistan: insights from the paediatric orthopaedic registry Pakistan (PORP). Pak J Med Sci. 2025;41(3):668-75.
8. Subaşı İÖ, Veizi E, Çepni Ş, Alkan H, Oğuz T, Fırat A. Clinical examination findings can accurately diagnose developmental dysplasia of the hip—a large, single-center cohort. Children. 2023;10(2):304.
9. Norlén S, Faergemann C. Developmental dysplasia of the hip in infants referred for a combined pediatric orthopedic and radiologic examination–a prospective cohort study. J Orthop. 2022;32:109-14.
10. Swarup I, Ge Y, Scher D, Sink E, Widmann R, Dodwell E. Open and closed reduction for developmental dysplasia of the hip in New York State: incidence of hip reduction and rates of subsequent surgery. JB JS Open Access. 2020;5(1):e0028.
11. Charki MT, Abdellaoui H, Atarraf K, Afifi MA. Surgical treatment of developmental dysplasia of the hip in children–a monocentric study about 414 hips. SICOT-J. 2022;8:29.
12. Danişman M, Çetik RM, Tuncay O, Yilmaz G. Intraoperative medial wall disruption in Dega pelvic osteotomy: does it effect the radiographic outcome at medium-term?. Saudi Med J. 2023;44(7):687-93.
13. Sari AS, Karakus O, Gultekin MZ, Senaran H. Acetabular index and acetabular depth ratio in newborns and infants aged 6 months or less with the healthy development of hips: a retrospective cross-sectional study. Medicine. 2023;102(16):e33631.
14. Rehman HFU, Amin MS, Shah MQA, Labib M, Iqbal MN, Qureshi BA. Role of Salter osteotomy in improving acetabular index of DDH patients measured by radiography pre-op and post-op. Pak Armed Forces Med J. 2025;75(Suppl-I):S2-S5.
15. van Stralen RA, Colo E, Rutz E, Schreurs BW, Hosman AJ. Long-Term Results After Salter Innominate Osteotomy for the Treatment of Developmental Dysplasia of the Hip—Only 8% Rate of Total Hip Arthroplasty at a Median Follow-Up of 22 Years. Children. 2024;11(12):1525.
16. Mahmud AI, Noman SA, Paul MC. Outcome of the treatment of developmental dysplasia of the hip after walking age with open reduction, varus derotation osteotomy with femoral shortening and acetabular osteotomy. Int J Res Orthop. 2025;11(2):325-31.
17. Suvorov V, Filipchuk V. Salter pelvic osteotomy for the treatment of developmental dysplasia of the hip: assessment of postoperative results and risk factors. Orthop Rev. 2022;14(3):35335.
18. Rampal V, Klein C, Arellano E, Boubakeur Y, Seringe R, Glorion C, et al. Outcomes of modified Dega acetabuloplasty in acetabular dysplasia related to developmental dislocation of the hip. Orthop Traumatol Surg Res. 2014;100(2):207-11.
19. Kandil AE, Mohamed Saeed AB, El-Barbary H, Hegazi M, El-Sobky M. Salter versus Dega osteotomy after open reduction of developmental dysplasia of the hip in young children. Egypt Orthop J. 2013;48(1):80-7.
20. El-Sayed M, Ahmed T, Fathy S, Zyton H. The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodeling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age: short-to middle-term follow-up. J Childrens Orthop. 2012;6(6):471-7.
21. Morsy A, El-Barbary HM, Abdelhamid M, Mostafa AG. Salter osteotomy versus Dega acetabuloplasty in management of developmental dysplasia of the hip in children above one year old. Turk J Physiother Rehabil. 2022;32(3):35987-36008.
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Dr. Safdar Iqbal
Senior Registrar, Orthopaedic Surgery, Sir Ganga Ram Hospital, Lahore.
Dr. Saif ur Rehman
Senior Registrar, Orthopaedic Surgery, Sir Ganga Ram Hospital, Lahore.
Dr. Muhammad Umair Shahid
Medical Officer/ Senior Registrar, Orthopaedic Surgery, Sir Ganga Ram Hospital, Lahore